RULE OF NINES
The rule of nines assesses the percentage of burn and is
used to help guide treatment decisions including fluid resuscitation and becomes part of the guidelines to determine transfer to a burn unit.
An adult who has been burned, the percent of the body
involved can be calculated as follows:
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Burns are injuries to the tissues caused by heat, friction, electricity,
radiation, or chemicals. Such injuries cause the breakdown of body
proteins, death of cells, loss of body fluids, and edema.
Five factors will help you to determine the severity of a burn:
1.
What is the depth of the burn?
2.
What is the extend of the burn?
3.
Are any critical areas (face, upper airways, hands, feet, genitalia,
circumferential burns) involved?
4.
Are there any preexisting medical conditions or injuries?
5.
Is the patient < 5 years or > 55 years?
Head = 9% (front = 4.5%, back = 4.5%)
Chest (front) = 9%
Abdomen (front) = 9%
Upper/mid/low back and buttocks = 18%
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A Superficial (first-degree) burn causes redness and swelling
in the outermost layers of skin called the epidermis.
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A Partial thickness (second degree) burn involves redness,
swelling, and blistering. The damage extends beneath the epidermis to the deeper layers of skin, the dermis.
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A Full thickness (third degree) burns, destroys the entire depth
of skin, causing significant scarring. Damage also may extend
to the underlying fat, muscle, or bone. Third-degree burns require immediate medical attention.
The severity of a burn is judged by the extend of body surface area
(BSA) involved as well as the depth of the burn.
Classification of Burns in Adults:
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Each arm = 9% (front = 4.5%, back = 4.5%)
Each palm = 1%
Groin = 1%
Each leg = 18% total (front = 9%, back = 9%)
As an example, if both legs (18% x 2 = 36%), the groin
(1%) and the front chest and abdomen were burned, this
would involve 55% of the body.
Burns vary depending on the cause, the intensity, and the body parts
involved. They are classified by depth, based on the severity of the
tissue damage:
Parkland Formula
for
Treating Burn
Victims
For burn victims, fluid resuscitation is critical
within the first 24 hours. The amount of fluid
resuscitation can be determined from the percentage of body surface area (%BSA) involved.
"Rule of 9's" can estimate the %BSA.
The Parkland Formula is as follows.
Fluid for first 24 hours (ml) =
4 ml of NS X Patient's weight in kg X %BSA
burned
Afterwards, the first 1/2 of this amount is delivered in the first 8 hours, and the remaining 1/2
is delivered in the remaining 16 hours.
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Critical Burns
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Full thickness involving hands, feet, face, upper
airways, genitalia, or circumferential burns of other
areas
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Full thickness burns covering > 10% TBSA
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Partial thickness burns covering > 30% TBSA
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Burns associated with respiratory injury (smoke
inhalation or inhalation injury)
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Burns complicated with fractures
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Burns on pt < 5 yo or > 55 yo that would be classified as “moderate” on young adults.
Moderate Burns
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Full thickness involving 2% - 10% TBSA excluding
hands, feet, face, upper airways, genitalia.
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Partial thickness burns covering 15% to30%
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Superficial burns covering > 50% TBSA
Minor Burns
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Full thickness covering < 2% TBSA
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Partial thickness burns covering < 15% TBSA
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Superficial burns covering < 50% TBSA
Classification of Burns in Infants & Children:
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Critical Burns
RULE OF PALM
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Full or Partial thickness covering > 20% TBSA
The palm method is a tool whereby the size of the patients palm is
used as an indicator for specific percentage of TBSA.
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Burns involving hands, feet, face, airway or genitalia
The surface area of a patients palm equals approximately 1% of
TBSA.
This method is particularly useful where the burn has an irregular
shape or has a scattered distribution.
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Moderate Burns
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Partial thickness burns covering 10% to 20% TBSA
Minor Burns
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Partial thickness burns covering < 10% TBSA